One of the leading causes of chronic kidney disease is diabetic kidney disease, where about one out of three adults with diabetes has CKD. Sadly, many patients come see me when it is too late to save the kidneys and they have to be placed on dialysis. This can be prevented with good control of blood glucose levels and regular consultation with your doctor to keep your kidneys functioning properly.

High blood glucose levels in diabetes not only damage the kidneys, but other parts of the body as well — your brain, eyes, heart, stomach, nerves.

We have a network of blood vessels all over the body and the smaller ones get affected first, and the damage is not obvious at first. But over time, this microdamage can build up and cause more problems.

In the kidney, there are millions of little filters called nephrons that clear waste products from your blood. When high glucose levels damage the blood vessels that help sustain these nephrons they don’t work as well as they should. About 30 percent of patients with Type 1 diabetes and 10 to 40 percent of those with Type 2 diabetes will eventually suffer from kidney failure.

In the early stages of diabetic kidney disease patients may not have any symptoms for many years. The earliest sign may be albumin or protein in the urine that is seen on a test called a random urine protein:creatinine ratio, seen long before levels of creatinine or blood urea nitrogen (BUN) are seen to increase. If you have diabetes it is important to have this urine test done at least once a year.

Other symptoms of kidney disease include:
High blood pressure
Swelling of the legs and ankles
Leg cramps
Unexplained weight gain
Increased urination, particularly at night
Nausea and vomiting
Bubbly urine
Loss of appetite
Weakness and increasing fatigue
Paleness and anemia
Itching of the skin

Less need for insulin or medications for diabetes
As a person with diabetes, you should have your blood, urine and blood pressure checked regularly, at least twice a year or more frequently as required by your doctor, usually every three months.

Maintaining a healthy weight is also important. Remember that you only have two kidneys that clean your body of waste. Compare your body to a house — the larger the house, the more difficult it will be to clean if there are only two people cleaning it, and they will get tired and run down sooner rather than later. That’s what can happen to your kidneys.

Other ways to keep your kidneys healthy is to get proper treatment for urinary tract infections and correct any problems in your urinary system.
Stay well hydrated and don’t hold your urine. Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications like ibuprofen or mefenamic acid) and ask your doctor before taking supplements or herbals that supposedly treat kidney disease as they may be unnecessary and may cause even more damage.

Most patients with diabetes also have high blood pressure. Some medications for blood pressure have been shown to help slow the loss of kidney function, called angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). There are also medicines for diabetes called SGLT2 inhibitors that have been proven effective in delaying the progression of kidney disease in patients with and without diabetes.

As with other medical conditions, recognizing the problem early and getting treated properly are important in ensuring more favorable outcomes.
Consult your doctor if you feel that you might be at risk for diabetic kidney disease.